TRAVEL HEALTH PROGRAM
DECEMBER 2018 NEWSLETTER

CDC WARNING LEVEL 3
 Avoid Nonessential Travel to the Northern Mariana Islands, Central Sulawesi, Indonesia and Venezuela

On October 25, 2018, Super Typhoon Yutu crossed the Commonwealth of the Northern Mariana Islands causing significant damage. There are problems with water supply, sanitation, food supply, electricity, transportation, shelter, communications, security, medical care, and mosquito control. In addition to safety hazards caused by debris and unstable buildings, there are serious health and safety risks, medical care may not be available, and visitors could further strain local resources. CDC recommends that U.S. residents avoid all nonessential travel to the Northern Mariana Islands. If travel to the area is necessary, follow CDC recommendations for health and safety.

Map - North Mariana Islands

Two recent natural disasters have caused severe damage, injuries and deaths in the province of Central Sulawesi, Indonesia. On September 28, 2018, earthquakes struck the Donggala region and triggered a tsunami wave that hit the Donggala and Mamuju regions and the city of Palu. In addition to safety hazards caused by debris and unstable buildings, there may be problems with sanitation, food supply, electricity, transportation, shelter, communications, security, and medical care. There are serious health and safety risks, medical care may not be available, and visitors could further strain limited local resources. CDC recommends that travelers avoid all nonessential travel. If travelers must go to the area or are doing humanitarian aid work, follow CDC health advice before, during and after the trip. For more information, visit the Department of State Travel Advisory for Indonesia.

ruins of a town after a disaster

There has been a breakdown of the medical infrastructure in Venezuela. There are shortages of food, water, electricity, medicine, and medical supplies that have contributed to an increasing humanitarian crisis affecting much of the country. Adequate health care is not available through the public health system. For this reason, in addition to crime and civil unrest, the U.S. government has limited ability to provide emergency services to U.S. citizens. Infectious diseases are on the rise, and several large outbreaks are occurring including measles, diphtheria, and malaria. CDC recommends that travelers avoid all nonessential travel to Venezuela. Travelers that must go to Venezuela should protect themselves by following CDC recommendations. For more information, visit the Department of State Travel Advisory for Venezuela.

Map - Venezuela

Outbreaks & Security Concerns

Africa
  • Health officials have reported an outbreak of dengue in Senegal. Travelers should protect themselves by following CDC recommendations to prevent mosquito bites.
  • Health officials have reported an outbreak of Monkeypox in Nigeria. There have been over 100 confirmed cases since September 2018 including multiple deaths. Monkeypox is spread through contact with humans or animals that have the virus. Travelers should protect themselves by frequently washing hands with soap and water and by avoiding contact with animals and humans that are sick.
  • An outbreak of Ebola is occurring in North Kivu (Kivu Nord) and Ituri provinces of the Democratic Republic of the Congo including the cities of Beni and Butembo. Travelers should take precautions to avoid contact with the blood and bodily fluids of infected individuals. The risk to most travelers is low. Those at highest risk of acquiring Ebola are healthcare workers and family and friends caring for the sick. This part of the country is identified as a "do not travel" zone by the U.S. State Department because of armed group activity and major outbreaks of violence targeting civilians.
  • There are current outbreaks of polio in NigerSomalia, Nigeria, and the Democratic Republic of the Congo. The CDC recommends that all travelers to these countries be vaccinated against polio. Additionally, adults who have been fully vaccinated should receive a single lifetime booster dose of the vaccine before travel. Travelers that will be in any of these countries greater than four weeks may be required to show proof of vaccination. Because of the risk of cross-border transmission, CDC recommends a one-time booster dose of polio vaccine for fully vaccinated adults traveling to Niger, Cameroon, or Chad to work in healthcare facilities, refugee camps or other humanitarian settings.
  • There is an outbreak of Rift Valley Fever (RVF) in Kenya. The outbreak has been confirmed in the countries of Wajir, Marsabit and Siaya. Travelers should avoid exposure to animals, animal blood, and mosquito bites.
  • There is a severe water shortage in Cape Town, South Africa. The city has implemented water restrictions of 70 liters of water per person per day. Travelers should reduce shower times to 90 seconds, avoid flushing toilets unless necessary, carry alcohol-based hand sanitizer, and should familiarize themselves with the most up to date water restrictions and recommendations for reducing water use.
  • Health officials have reported several cases of measles in the Democratic Republic of the Congo and Madagascar. CDC recommends that all international travelers protect themselves by making sure they are appropriately vaccinated against measles.
  • There is an ongoing outbreak of yellow fever in Nigeria that began in September 2017. Cases have been reported in at least seven states, and multiple people have died. CDC recommends anyone 9 months or older who travels to any part of Nigeria should be vaccinated against yellow fever. In addition, Nigerian authorities require proof of yellow fever vaccination from all people one year of age or older who are traveling to Nigeria and are arriving from a country with risk of yellow fever virus transmission. Because of current limitations in the availability of yellow fever vaccine in the United States, travelers should contact a yellow fever vaccine provider well in advance of travel.
  • Check the World Map of Areas with Risk of Zika to find out about countries in Africa with risk of Zika. Refer to the Current Zika Virus Recommendations below on how to prevent Zika virus infection when traveling to these countries.
Asia
  • Avoid all nonessential travel to Central Sulawesi, Indonesia due to September 28, 2018 earthquake and tsunami damage. See above warning for details.
  • Health officials have reported an outbreak of rubella in Japan. Rubella is also called German measles and is spread by the coughs and sneezes of infected people. Rubella is dangerous for pregnant women and their developing babies. Pregnant women who are not protected against rubella through vaccination or previous rubella infection should not travel to Japan during this outbreak. All travelers to Japan should make sure they are fully vaccinated against rubella with the MMR (measles, mumps, and rubella) vaccine before travel. 
  • Health officials in Pakistan have reported an ongoing outbreak of extensively drug resistant (XDR) typhoid that does not respond to most antibiotics. All travelers to Pakistan are at risk of acquiring typhoid fever, but those visiting friends and relatives are at highest risk.Travelers should receive the typhoid vaccine before departure to Pakistan and should take extra care to follow food and water guidelines as recommended by the CDC.
  • There is an outbreak of measles in the Philippines and Indonesia. CDC recommends that all international travelers protect themselves by making sure they are appropriately vaccinated against measles.
  • The Malaysian state of Sarawak has declared parts of three divisions to be rabies infectious areas. Travelers who anticipate contact with animals such as dogs, cats, bats, or other carnivores should consider rabies vaccination before travel. Even if the pre-exposure rabies vaccine has been received, travelers should still get immediate medical treatment if bitten or scratched by an animal during travel.
  • Check the World Map of Areas with Risk of Zika to find out about countries in Asia with risk of Zika. Refer to the Current Zika Virus Recommendations below on how to prevent Zika virus infection when traveling to these countries.
Caribbean, Central and South America
  • Avoid all nonessential travel to Venezuela due to ongoing humanitarian crisis. See above warning for details.
  • There is an outbreak of measles in Brazil. Over 5,000 cases have been reported in the states of Amazonas and Roraimas. CDC recommends that travelers to Brazil be fully vaccinated against measles.
  • There is a large, ongoing outbreak of yellow fever in multiples states of Brazil. Since early 2018, several unvaccinated travelers to Brazil have contracted yellow fever; many of these travelers were infected on the island of Ilha Grande (Rio de Janeiro State). It is now recommended that travelers receive the yellow fever vaccine if visiting or living in all of Espirito Santo State, all of Rio de Janeiro State, including the city of Rio de Janeiro and all coastal islands, all of São Paulo State, including the entire city of São Paulo and all coastal islands, all of Parana State, Santa Catarina State, Rio Grande do Sul State, and a number of cities in Bahia State. Because of a yellow fever vaccine shortage in the United States, travelers should contact a yellow fever vaccine provider well in advance of travel. People who have never been vaccinated against yellow fever should avoid traveling to the affected areas of Brazil.
  • Check the World Map of Areas with Risk of Zika to find out about countries in the Caribbean, Central and South America with risk of Zika. Refer to the Current Zika Virus Recommendations below on how to prevent Zika virus infection when traveling to these countries.
Europe Middle East
  • There is an outbreak of measles in Israel. CDC recommends all travelers protect themselves by making sure they are appropriately vaccinated against measles.
  • There is an outbreak of leptospirosis in the Golden Heights region of Israel. Leptospirosis is spread through contaminated fresh water sources like rivers, streams and lakes. Seven water sources have been identified in this outbreak and most of them have been closed to the public. Travelers should follow CDC recommendations to prevent the disease.
  • Cases of vaccine-derived polio have been reported in Syria. CDC recommends that all travelers to Syria be fully vaccinated against polio. In addition, adults who have been fully vaccinated should receive a single lifetime booster dose of polio vaccine. Proof of vaccination may be required if travelers intend to stay in Syria for more than 4 weeks.

Pacific Islands and Australasia

  • Avoid all nonessential travel to the Northern Mariana Islands due to Super Typhoon Yutu on October 25, 2018. See above warning for details.
  • There is an outbreak of measles in New Zealand. CDC recommends all travelers protect themselves by making sure they are appropriately vaccinated against measles.
  • An outbreak of polio has been reported in Morobe Province, Papua New Guinea. Adults who have been fully vaccinated should receive a single lifetime booster dose of polio vaccine before travel. CDC recommends that all travelers to Papua New Guinea be fully vaccinated against polio. Proof of vaccination may be required if travelers intend to stay in the area for more than 4 weeks.
  • Check the World Map of Areas with Risk of Zika to find out about Pacific Islands with risk of Zika. Refer to the Current Zika Virus Recommendations below on how to prevent Zika virus infection when traveling to these countries.

Traveler Health & Safety Tips

Heading Home Health Video - watch now

The CDC recommends all travelers:

  • Visit a health care provider 4 to 6 weeks before their trip for personalized health advice, vaccines, and medications.
  • Avoid bites from mosquitoes and other bugs by using an insect repellent and wearing long-sleeved shirts, long pants, closed shoes, and hats as much as possible.
  • Stay safe around animals. Do not pet, handle, or feed unfamiliar animals, even pets.
  • Be safe on international roads. Avoid overcrowded buses and cars, always wear a seat belt, and wear a helmet when riding a bike or motorcycle.
  • Wash their hands often with soap and water and use a hand sanitizer as needed.

Current Zika Virus Recommendations

  • Check the World Map of Areas with Risk of Zika before you travel.
  • The recommendations for travelers to areas with risk of Zika are:
    • CURRENT PREGNANCY: Women who are pregnant (in any trimester) should not travel to areas with risk of Zika. Men who have traveled to an area with risk of Zika who have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sexual intercourse for the duration of the pregnancy. 
    • MOSQUITO AVOIDANCE: Prevent mosquito bites while traveling to areas with Zika virus transmission, and for three weeks after returning to the U.S.
    • PLANNING PREGNANCY: If you or your partner are trying to get pregnant, consider avoiding travel to areas with a CDC Zika travel notice. Women should wait at least eight weeks after travel before trying to get pregnant. Men should either consistently and correctly use condoms during sexual intercourse or not have sexual intercourse for at least three months after travel to an area with Zika virus transmission. 
    • SYMPTOMS AFTER TRAVEL: Zika virus testing should be offered to people with symptoms of Zika virus disease, including pregnant women and others who develop symptoms during or following travel.

Resources

This email distribution tool is supported by funding from grant U01CK000175 of the U.S. Centers for Disease Control and Prevention (CDC) to the Massachusetts General Hospital. The tool attempts to capture up-to-date notices and alerts at the time of posting; however, components of this information are constantly changing. By using this tool, you agree that the Massachusetts General Hospital and tool developers/supporters are not liable for any adverse outcomes, including those relating to travel.

 

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